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Request an Appearance

Complete and submit this form to request Congressman Smucker’s appearance at a meeting, speaking function, or a non-speaking function. Due to the Member’s schedule, not all requests will be filled.

marks required fields of data.

Activity Details

Type of Request:

Location of Event:

Date of Engagement:

Number of Attendees:

Names of Attendees:

Topic of Engagement:

Details:

Your Information

Prefix:

First Name:

MI:

Last Name:

Suffix:

Organization:

Your Title:

Organization’s Website:

Street Address:

Street Address Continued:

City:

State:

ZIP Code:

Email:

Telephone

Phone Number / Type:

What are these options?
Constituents who are hard of hearing or use a video phone have the option to choose TDD or VP based on the type of device they are using. This allows our office to respond to them accordingly. The default option "Voice" is a standard audible telephone.